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Doctors tackle health reform questions
Doctor holds out stethoscope
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TEXT OF INTERVIEW
Kai Ryssdal: The new health care law is almost a month old now. Just barely 30 days. Which means most Americans still don't really know how it works. And they are asking the next best thing they can think of to an expert -- their doctors -- for help. So instead of the usual talks about cholesterol and blood pressure, some physicians are having to educate themselves on the minutiae of reform. We've called Dr. Winston Capel. He's a neurosurgeon in Jackson, Miss. to talk about this. Dr. Capel, welcome to the program.
Dr. Winston Capel: Good to be with you.
Ryssdal: What do you hear from your patients when they come in for a check up, and they start asking about health care reform?
CAPEL: Well, there's been an evolution from the time of the debate and passage til today. So initially during the very short debate and the passage, emotion was high, they were outraged, and then significant anxiety over the impact on them personally and how delivery would be affected. Then secondarily they were concerned about how it would impact us as physicians.
Ryssdal: Do you have the answers for them?
CAPEL: I do my best. I tell them it's certainly a dynamic process that's going to be challenged, it's going to be debated, and how it's going to impact us now is very difficult to tell them.
Ryssdal: So somebody comes in for a half hour, 40 minute consult, how much time do you think it takes away from your delivery of care?
CAPEL: It's averaging between five and ten minutes now.
Ryssdal: Which adds ups.
CAPEL: It does. And it's not something that we are completely fluent in, but I try to get them some insight as best as I can.
Ryssdal: How long do you think it's going to be before your patient can then come in and maybe not have these questions, or maybe just a couple that you could knock out right away and then get on to the examination?
CAPEL: We're seeing a little bit of decreased frequency just because they understand the answers just aren't here. But they're still anxious, they're still certainly very concerned.
Ryssdal: So we did some calling around trying to find doctors to talk about, and you know, there were some who said, yes, I've had patients complain, and there were some who said, no, my patients don't really mind. What do you guys at the watercooler, or in the doctor's lounge, or wherever you meet your colleagues, what is your conversation between yourselves?
CAPEL: Well, I could tell you this, one thing that frustrates me and my colleagues, when people talk about health care reform, they key in on three issues: the cost, the quality and the access. The one thing that is completely lost in the debate is physician morale. Physician morale is at an all-time low. And by data, we know through published data that two out of three physicians would leave medicine tomorrow if they could.
Ryssdal: What about you?
CAPEL: I would leave tomorrow if I had an alternative career. I love the science, and I love taking care of patients, but things that kill our morale are, number one, the medical malpractice threat, which looms over us every hour of every day, number two this intrusion into the patient-physician relationship, which we treasure, and the more layers of bureaucracy that separates us from our patients, the less gratifying it becomes.
Ryssdal: Dr. Winston Capel. He's a neurosurgeon in Jackson, Miss. Dr. Capel, thank you so much for your time.
CAPEL: Thank you.
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I just wanted to take the time to add a different perspective, a patient's perspective! I am one of the hard working Americans with a back problem. I came to see Dr. Capel in January 2010, and he promptly scheduled me for surgery to correct the issue. Three weeks after surgery, I had the complication of CSF (Cerebral Spinal Fluid) Leak, for which I had two surgeries to correct. All under Dr. Capel's care, and I must tell you, there was a calming feeling everytime "I went under his knife" knowing that I had one of the best physicians in the nation there to help me! You can tell that he is one of those doctors that cares about his patients, and all the issues surrounding the uncertainty that the medical profession faces does not radiate into his practice at all... I believe him when he says that he practices medicine for the love of the science, and trying to help people. If you ever have the opportunity to sit in his care you will find this to be true as well!For this is a doctor who sat at my bedside, constantly reassured me that everything would be better, called me at home to check on me constantly, promptly returned any calls made to him, openly answered any questions I had, and even had his kids praying for me!
So for all of you who wish to stereotype this doctor as a specialist who is "out of touch" with reality, the only part of what you say that is true is that he is "special!" He is hands- down the greatest doctor/surgeon that I have ever been associated with!
And for all of you who are so interested in what he drives, all I can say is that he so chooses to drive a BMW, go for Dr. Capel you deserve it, get a canary yellow one!!!
It surprises me that there are sooo many of you "primary care" physicians that feel so slighted by Dr. Capel's comments! Being a primary care physician also that happens to know Dr. Capel and works about 5 miles from his office: he does accept Medicare, Medicaid, and uninsured patients. It is pretty obvious that some of you "primary care" physicians don't know squat about the work he does to care for his patients, in spite of hospital regulations, professional liability insurance regulations, Medicare/Medicaid paperwork and regulations, and just basic running the business of neurosurgery. He's not the arrogant physician some of you have made him out to be and he's proven to me to be a fine doctor. I say get off his case and if you think you can do a better job, go be a neurosurgeon! Dr.
Most countries don't do more for less $$. They often reprocess items that are to be one time use devices(viruses,prions,malfunctioning equipment?) or just don't offer advanced services. If you believe Michael Moore, Cuba is the center of advanced healthcare for the lowest cost. The country rations soap and sugar but somehow provides better medical care then the USA. NO, stop with the lies.
Call schedule for a surgeon is almost always way beyond what a family practicioner or medical specialist covers. Oncology, pulmonology are hardly ever come in on an emergency basis. Nephrology maybe. Patient can't breathe acutely-anesthesia intubates them emergently then pulmonology can see them the following day. At my hospital, there are no pulmonologists--airway foreign body--call general surgery for stat bronchoscopy. A big cancer is found..call general surgery for urgent biopsy or removal..then oncology can treat the disease. Patient not doing well, maybe general surgery can give insight. I can work a 7am-noon shift without breaking a sweat-don't make me or any other surgeon laugh. I often work 12+ hours on my feet, go home for an hour or two(try to get atleast one meal a day) and get called back for more consults or surgery. I laughed when my medical co-residents complained of 60 hour work weeks--so strenous when the surgery residents did 80+ all the time for several more years. As hospitalists do more admissions, family doctors are gaining some ease to a hectic lifestyle. Now they can manage their outpatient practice and not have to do middle of the night admissions. And don't think your surgeon can't handle most medical emergencies--we didn't operate the entire time of residency. There are morale issues with every medicine field and this healthcare bill will likely make them worse. Everybody would like more pay for less work. I just want adequate payment for hard work--I don't need to worry about >20% cuts in government or private insurance payments to cover business costs. My staff and family need taken care of too. Me and my family come last in that equation. Riots in Greece are happening for less cuts then what the medical community is being dealt. I'm just amazed at how many doctors think the healthcare bill is a panacea for our woes. There is no more money going into the system to pay for more care. Doctors will work more for less (more patients, more paperwork, more quality measures....), guaranteed. And please, stop sending me only young, healthy patients--I wonder where all your sicker patients go when they need surgery? Hypertension, diabetes, hypercholesterolemia, obesity, heart disease, COPD-that's half my patients.
From an MD - - The FP / internal medicine MD's certainly seem miffed about Dr capel's comments - the truth of the matter is that neurosurgery is a specialty without a substitute practitioner . . it is a therefore a vocation with a wide moat, adn therefore more money. There is simply NO substitute for a neurosurgeon for a head bleed, intracranial pathologies, etc. . . Like it or not, the FPs have allowed the RNP to participate in the delivery of care, . . .why have they allowed the perception that a nurse can provide equal care / do the same job (they ceratinly do not). . . stop blaming the specicalists, adn start looking at what primary care has done to shoot themselves in the foot by empowering "physicain extenders" . . .
Some of the comments I have read here are so unbelievably ignorant, it is just sad. It would do most of the bloggers good to re-read Jon Steadmans post. He reminds us that so much more is wrapped up in our healthcare providers than we realize. Most of the bloggers here would have you believe that these doctors just walked in off the street, filled out an application, got the job and that's it! Also, Elizabeth Leonard (see post) had a good point---C'mon, people! This is one quick interview with one well regarded doctor---world leaders aren't gathering around to pick apart each word he uttered in order to make changes. It was the topic from Dr. Capel's perspective and I'm sure there are many people who share it. I happen to be one of them.
Obviously, the comments by many of the listeners are also very biased in favor of liberals. The question that was asked Dr. Capel was about patients questioning him about health care reform. The problem with the new health care bill is that no one really knows how it will impact patients, doctors, or us as tax paying citizens. The health care bill does nothing towards medical malpractice which is one issue in controlling costs along with many other issues. It also does nothing to control yearly double digit increases in insurance premiums. It also didn't address the 21% reduction in Medicare reimbursement, which I think will create a current health care crisis. Many physicians will not be able to afford to see medicare patients and keep a viable practice running. I would say that the majority of physicians are in favor of some type of health care reform, but having the government control health care is not the solution, as can be seen with the VA system, Tricare, or even Medicare/Medicaid. As I review the comments made by Dr. Capel he seems to be making some statements about issues that no one has thought about such as physician morale and physician concerns. Patients want to be treated by physicians that are motivated, appreciated, and get satisfaction out of practicing medicine. Health Care Reform was being formulated by politicians, lawyers, but not involving physicians. The comments that I have read from FP's and Internists seem to bring out hard feelings that these physicians have towards specialists. What I find ironic is that these primary care physicians made the choice to practice in there current specialties, just as the surgeons have made there choice. The sad part of the health care reform bill was how it was rushed through without the traditional voting that is done on bills. This bill has more to do with politics than it has to do with health care reform in this country or taking care of the uninsured. If is was truly about doing the best for health care in this country there would have been a lot more research and discussions into the real issues with coverage, costs, and even how to maintain the quality that our country expects. Unfortunately, with liberals and conservatives the health care debate has been all political and not addressing the main issues of our current health care problems. I have noticed with the listeners that have commented that they aren't really looking at the realities this issue, but are playing politics like our current legislators have been. Thank you Dr. Capel for your insightful opinion on this issue.
I have reviewed the ingnorant and misinformed comments from a host of bloggers. FYI: I see uninsured patients 2-4 a day without compensation with unlimited liability, the morale problem preceeds HC reform, I never expressed any opinion on the content of HC reform, remember I was called in the middle of a busy office day "juggling multiple medical issues as they impact a complex spinal issue, I spent 7 years in residency working 140 hours/week, I do not drive a BMW (drive a car with 130,000 miles on it, my kids go to public schools. I am so surprised at the animosity from primary care towards me. You guys don't get it. I know I work just as hard and take care of medicaid patients, uninsured patients,ect. The ignorance and assumptions makes me wonder where you guys are coming from. Just remember when you come to me with the difficult spinal or brain problem I will treat you with the expertise the required 20+ years to acquire. I have sacrificed immensely to be a compassionate doctor. Shame on you for your ignorance. You are supposed to be educated professionals but communicate stereotypes, assumptions that I would not expect from a so called collegues. Your animosity and misinformed views will only be exploited by those that ultimately will destroy our HC delivery system. I do believe the system is broken and needs reform, but needs to be done the right way. HC is a very complex process and can't be solved with one bill. I would like to have some of you follow me around for a day. Next time someone calls for a life or death emergency I will let you handle it, I will go do the paper work I already do, coordinate the care, spend time talking to pts (I do a lot of this) You handle the emergency: good luck to you and the patient! Maybe, maybe your views will change. Ignorance is sometimes incurable!
I came to this comment page to respond to Kai's interview with Dr. Capal, which was billed as a conversation with "the next best thing to an expert." Nearly inarticulate with frustration over the lack of expertise in the interview, I was happy to find that several other people - particularly Christy Bannister and Eric Wade - had already clearly pointed out the interview's shortcomings (see their posts). I suspect Dr. Capal is an able surgeon and caring MD, but his comments revealed not only a total lack of expertise but not even the rudimentary understanding of health care reform that one could get from, say, reading the newspaper.
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